Nicole sat on a chair for half an hour. She says it cured her stress incontinence.

Since having her fourth child, Nicole suffered from stress incontinence.

It wasn’t severe, but still caused her problems. Her youngest is now five and she’s plodded along, accepting it as a normal part of her life.

“I get up throughout the night to go the bathroom and think nothing of it. The kids have made fun of me if I laugh too much. I once had an incident on the Scooby Doo ride with my daughter whilst on holidays on the Gold Coast,” she told Mamamia.

Nicole is a registered nurse and founder of Trusted Surgeons, a platform that allows users and plastic surgeons to interact and engage with each other in a safe, online space.

During a visit to the 2018 ASAPS Non-surgical symposium in the Gold Coast earlier this year, she stumbled upon the booth for the BTL Emsella, marketed as a chair that uses high-intensity focused electromagnetic technology (HIFEM) to cause deep pelvic floor muscles stimulation and restoration of the neuromuscular control.

The pelvic floor muscles support the bladder and vagina so exercising and strengthening these muscles can reduce urinary incontinence.

BTL business development manager Gareth Pepper told Mamamia that each therapy lasts 28 minutes. During that period, the Emsella induces 11,200 supramaximal contractions of the pelvic floor.

When she stumbled upon the Emsella booth, Nicole was at first nervous – talking about her incontinence makes her very uncomfortable.

“As I stood with my pelvic floor tense and legs crossed, I listened to Gareth and Petra [at the booth] explain the Emsella. Within minutes my clenching subsided, everything relaxed (no accidents) and I was sittingon the magical chair,” she said. “It turns out the Emsella treats the entire pelvic floor area whilst the patient is fully clothed. Yes, nothing invasive being stuck where it doesn’t belong.”

Nicole sat on the Emsella for the full 28-minute course. She said it felt like she was doing a pelvic floor workout, but all she did was sit there. She noticed a difference right away.

"The following night I thought I would test myself and drink loads of water all evening and again I did not wake up. It really did work. I noticed a significant improvement in my quality of life and for the first time ever, I realised that stress incontinence was not something I had to live with."

Pepper told Mamamia the Emsella is TGA certified. He said BTL has successfully installed hundreds of chairs in the US, and they can also be found throughout Europe and Asia.

Dr Jenny King, Head of Department of Urogynaecology at Westmead Hospital, told Mamamia that magnetic stimulation can make muscles contract and eventually increase in bulk.

Most of the research in this area has concentrated on muscle and nerve regeneration after trauma but from 2000, electromagnetic stimulation has also been suggested for treatment of urinary incontinence, she said.

She said to date, the data on electromagnetic stimulation for urinary incontinence has been very mixed in quality and outcomes.

"There is only one study which has attempted to randomise patients to compare pelvic floor muscle training with the magnetic chair. This study found no significant difference in outcome between the two groups but importantly, in this age of limited health budgets, calculated the cost for electromagnetic therapy was almost three times that for five sessions with a senior pelvic floor physiotherapist.

"So despite the glossy website claims of being "backed by science", the reality is that we do not have sufficient information to support the efficacy of electro-magnetic stimulation over conventional pelvic floor muscle training."

She also pointed out that no studies have reported any major side-effects or complications.

BTL supplied Mamamia with three studies that concluded HIFEM technology is an effective treatment for stress incontinence.

Non-surgical treatments for stress incontinence are based on strengthening pelvic floor muscles and using them to minimise leakage. This can include vaginal gadgets that trigger muscle contraction to stop the device falling down.

Dr King said the proven most effective treatment is to work with an experienced pelvic floor physiotherapist or continence nurse.

"They will assess bladder habits, bowel problems, fluid intake, exercise activities, sleep hygiene etc – all of which are important in long term management of incontinence," she said.

For Nicole, the idea of an invasive procedure or having someone stick something in her vagina was a no-go, which is why electromagnetic stimulation was so appealing.

She wanted to complete the course, so reached out to BTL. She was disappointed to find it was only new to Australia, and no one near her had one.

"The reality is, [women with incontinence] are hiding in the wings, desperately awaiting a treatment like this. I ended up having a second treatment on an Emsella in their office, I can confirm I no longer wake through the night. I realised I have not had a full night without getting out of bed since prior to my fourth child. This device has changed a sacred and unspoken area of my life."

Pepper said he hoped that there would be 5-10 Emsella chairs available in major cities within a year.

Dr King said that while Emsella is not readily available, there are other brands offering similar treatment.

She said electromagnetic stimulation should not be recommended as standard management for stress incontinence until it has been properly researched and there is sufficient scientific data to back up its usefulness.

"Urinary incontinence is very common and undoubtedly a major quality of life problem for many. But it is not ugly and we are not less than perfect if our bladders leak a bit. We have tested and proven management options to work on this. Many women can become self-reliant rather than device dependent."